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History of Psychiatry in Thailand Pichet Udomratn M.D.

J Psychiatr Assoc ThailandVol. 53 Supplement 1 August 2008

15S

J Psychiatr Assoc Thailand 2008; 53(Supplement 1): 14S-21S

* Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai,Songkhla 90110, Thailand.

History of Psychiatry in ThailandPichet Udomratn M.D. *

Abstract

The first of November, 1889 could be called çthe dawn of psychiatryé in Thailand, as this

was the date when 30 psychotic patients were brought to be taken care of in an old building of

a nobleman, Praya Bhakdibhattarakorn, located in the vicinity of Klongsarn, Thonburi. Thereafter,

a long history of development has resulted and the original location is now known as Somdet

Chaopraya Institute of Psychiatry, the first psychiatric hospital of the country.

An important turning point in the march to a new era can be marked in 1942 when

Dr. Phon Sangsingkeo assumed the position of director. The hospital commenced a period of

remarkable reformation in many respects, becoming a modern institute of psychiatry. The services

were improved and iron bars on cells were eliminated, replaced by moral treatment. Words are

inadequate to describe the tremendous contributions the late Professor Dr. Phon Sangsingkeo,

the father of Thai psychiatry, made to the development of psychiatry and mental health in

Thailand. He was also the founding president of the Psychiatric Association of Thailand.

After Dr.Phon Sangsinkeoûs period, psychiatry in Thailand has been further developed in

the same way as in Western countries, especially when many Thai psychiatrists returned from

studying abroad. Psychiatry in Thailand has been much developed so far beyond anyoneûs

dreams of 1889, nearly 120 years ago. However, due to a shortage of psychiatrists, psychiatry

in Thailand still has some problems to be solved. With many strategic plans that have been

implemented, we hope and expect a brighter future for Thai psychiatry within the next decade.

Key words: history, mental health, psychiatry, Thailand


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IntroductionPsychiatry in Thailand has a long history1,2.

It has undergone continual improvement and

development over the past century to suit the changing

social, economic and cultural climate and to keep up

with technological advances. Psychiatry or mental health

operations in Thailand was previously divided into seven

periods up to 2001.3 In this review, the author has

added two more periods after 2001. The developments

in these nine periods will be elaborated on with the

first seven periods following the currently accepted

definitions.

Nine Periods of Thai Psychiatry1. The Asylum Period (1889-1924).

Mental health services were once concealed within

general health services, religious ceremonies and other

administrative activities. Thailandûs first psychiatric

hospital was established in 1889 in the reign of King

Rama V at Pak Khlongsan on the western bank of the

Chao Phraya River and named ùThe Asylumû. So the

first of November, 1889 could be called çthe dawn of

psychiatryé in Thailand, as this was the date when 30

psychotic patients were brought to be taken care of in

an old building of a nobleman, Praya Bhakdibhattarakorn,

located in the vicinity of Klongsarn, Thonburi. Thereafter,

a long history of development has resulted and the

original location is now known as Somdet Chaopraya

Institute of Psychiatry, the first psychiatric hospital of

the country. At the time çThe Asylumé was under the

jurisdiction of the Department of Nursing and the

Ministry of Dharmakara (now the Ministry of Education).

To begin with, patients were admitted here more for

administrative than treatment reasons. In 1905,

the Asylumûs administration was transferred to the

Sukhaphibal Medical Division, at the Ministry of City

Administration. Dr. Hugh Campbell Highet, head of the

Sukhaphibal Medical Division, became its director and

introduced new and more humane treatment and care

protocols.

2. The Psychiatric Hospital Period (1925-

1941). In 1925, the Asylumûs administration changed

hands again and came under the control of the Disease

Detection and Treatment Division of the Ministry of

the Interior. That year, a number of medical doctors

graduated from medical school in Thailand and the

authorities were prompted to issue new regulations

barring certain positions of authority to foreigners. Luang

Wichian Baedyakhom, then a doctor based at the

Central Hospital, was appointed as Thailandûs first

psychiatric hospital director. He was also the first Thai

doctor to study psychiatry on a two-year scholarship in

the USA. On his return, he changed the institutionûs

name from ùAsylumû to ùPsychiatric Hospitalû to help

change public perceptions. He also launched the

first technical and staff development programmes in

Thailand, laying important groundwork for future

psychiatric training. During Dr Luang Wichian

Baedyakhomûs tenure, a number of psychiatric

hospitals were built in the Thai regions to broaden the

extent of mental health care in Thailand. On the 50th

anniversary of mental health provision in Thailand (1939),

a Mental Health Division was formally established by

Royal Decree as part of the Public Health Department

of the Ministry of the Interior. This division was

subdivided into three sections-central, psychotherapy



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and mental hygiene - and Luang Wichian Baedyakhom

was appointed as its first director.

3. The Mental Health Period (1942-1960).

An important turning point in the march to a new era

can be marked in 1942 when Dr. Phon Sangsingkeo

assumed the position of director of Somdet Chaopraya

Hospital. The hospital commenced a period of

remarkable reformation in many respects. The services

were improved and iron bars on cells were removed

and treatment was improved with a moral treatment

approach. Words are inadequate to describe the

tremendous contributions the late Professor Dr. Phon

Sangsingkeo made to the development of psychiatry

and mental health in Thailand. His goal-directed

perseverance for over 15 years convinced the medical

school to accept psychiatry as a discipline and resulted

finally in both the establishment of the first Department

of Psychiatry in Thailand, and also in restructuring the

medical curriculum from 12 to 204 hours of psychiatry,

running throughout the four undergraduate years.

In the same year that Dr. Phon Sangsinkeo was the

director, The Ministry of Public Health (MoPH) was

established and a Royal Decree proclaimed the

reorganisation of the Department of Medical Services.

The decree also authorised the transfer of all mental

health matters from what was the Mental Health

Division to the new Psychiatric Hospital Division - the

latter supervised five psychiatric hospitals. Treatment

was, by this stage, extensively available, but the

psychiatric hospitals were beginning to experience

problems in accommodating the increasing numbers of

psychiatric patients. A Mental Hygiene Clinic was opened

at Somdet Chaophraya Hospital to help alleviate the

problem. Later still, this clinic was expanded to the four

corners of Bangkok to provide outpatient mental health

services and the Child Mental Health Centre on Rama

VI Road in Bangkok became the central clinic office.

Unfortunately, due to staff shortages, all but the Child

Mental Health Centre were shut down in 1970. New

therapeutic techniques from the West were also

introduced between 1942 and 1960. For example,

transquiliser therapy, psychotherapy and behavioural

therapy, all of which were applied through the group

work of mental health teams comprising psychiatrists,

clinical psychologists, psychiatric nurses and psychiatric

social workers. In 1955, a postgraduate training

programme in psychiatry was introduced for doctors for

the first time at Somdet Chaophraya Hospital. Towards

the end of this very active period, the Psychiatric

Association of Thailand (PAT) was founded in 1953 and

thus became the first private organisation with a role in

the countryûs promotion of psychiatry, study and

prevention of psychiatric illness, organisation of an

annual academic meeting for psychiatrists, publication

of a journal and textbook, and giving public education

on the topic of psychiatry and mental health.

4. The Early Community Mental Health

Period (1961- 1971). In this period, the Government

began to implement the first National Economic

and Social Development Plan (1961-1966). The agenda

included mental health in the form of the Psychiatric

Hospital Project, one of 22 health development

programmes. This project was geared towards

expanding and improving various operations. In 1964,

the first community mental health operation began to

take concrete shape. Dr Sakondh Sobhano, then


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director of Suan Saranromya Hospital, organised

a mobile psychiatric unit to serve the people of the

southern provinces. The service helped to extend

mental health provision and facilitated medical

check-ups and treatment closer to the onset of mental

disorders. The treatment and rehabilitation of mental

patients continued to develop. Novel services, such as

the Day-care Hospital at Somdet Chaophraya Hospital,

the Milieu Therapy Programme and the building of

a rehabilitation village based on the halfway house

concept at Srithanya Hospital, were introduced. The aim

was to help mental patients cope with everyday life,

work, and leisure time within the community but

under professional supervision, protection and support,

until they were fit to return home. In the second

National Economic and Social Development Plan

(1967-1971), mental health was represented by a

project to improve mental and neuropsychiatric

hospitals and a project to set up psychiatric wards in

general hospitals. A psychiatric ward was opened at

Prajadhipok Hospital in Chanthaburi province and

similar units were opened at Saraburi and Yala

Hospitals. In 1971, as part of the continuous

development of community mental health, the Chainat

Community Mental Health Centre was set up to provide

access to mental health services at a community level.

A central mobile mental health centre was opened on

Charoenkrung Road in Bangkok, which served as

the administrative and technical support centre for

other mobile mental health units in the regions. This

operation was run continuously until 1983. Towards the

end of this community mental health period, mental

health operations became the responsibility of the Mental

Health Division in the Department of Medical Services

at the Ministry of Public Health. This division controlled

22 hospitals and centres that received an annual

budget of 80m baht with more than 4,000 staff.

5. The Integration into General Health

Service Provision Period (1972-1981). This

period corresponds to the third National Economic and

Social Development Plan (1972-1976). Under the third

plan, mental health was considered part of General

Health Development Policy. There was emphasis on

psychiatry and community mental health operations and

the major project focused on the development of

community mental health provision to achieve the

desired quality and ensure coverage of the target

population. The fourth National Economic and Social

Development Plan (1977-1981) made community

mental health service provision one of the 11 key goals

of the health care system. This sought to integrate mental

health into general health care to the extent that people

would seek mental health services from their own local

general health facilities (i.e., central or general hospitals

rather than psychiatric hospitals). The mental health

agencies would provide technical support. This system

aimed to speed up services and to be truly holistic in

combining the physical and mental aspects of healing.

6. The Primary Health Care Period

(1982-1991). Under the fifth National Economic and

Social Development Plan (1982-1986), mental health

operation took the form of the Mental Health Plan.

All projects were carried out in support of the

development of the fundamental general health care

structure and primary health care operations. Mental

health and general health care provision were



19S

successfully integrated in Nakhon Ratchasima province

and this led to further expansion of the community

mental health project, which continued under the

sixth National Economic and Social Development Plan

(1987-1991). At the end of this period, in 1991, the

College of Psychiatrists of Thailand was founded which

later was named as the Royal College of Psychiatrists

of Thailand (RCPsychT). This organisation is under the

Thai Medical Council. Its aim is to assure the standard

and quality of postgraduate psychiatric training in

various institutions. The organisation proposed the

National Board of Examiners in Psychiatry to the Thai

Medical Council every two years. After the RCPsychT

was established, it also jointly took a major role with PAT

to organise the annual academic meeting for psychiatrists.

7. The Mental Health Promotion and

Prevention Period (1992-2001). The major

objective of the Mental Health Plan under the seventh


(1992-1996) was to get a better understanding of the

psychological profile of the general public and to

promote public participation in creating self-reliance

among and support for the mentally ill. There was

active promotion of mental health, mental health

awareness and mental illness prevention through close

collaboration with various state agencies. For example,

the development of a çlife skills programmeé was

introduced into the education of students at various

levels. The overall aim was to foster a healthy mental

state and to raise the quality of life of the population as

a whole. In terms of service provision, the plan

continued to work on the integration of mental health

into general health service provision and the community

care of mentally ill patients within their families and

communities. An important restructuring move was

initiated in 1993. The Mental Health Division was

upgraded by Royal Decree to the Institute of Mental

Health. It was simultaneously endowed with department-

equivalent status under the supervision of the Ministry

of Public Health. In 1994, the Department of Mental

Health was reorganised by Royal Decree. The new

department, still under the Ministry of Public Health,

has 12 subdivisions. The Health Development Plan of

the eighth National Economic and Social Development

Plan (1997-2001) listed the following goals in mental

health:

ë The reduction of the incidence of mental

disorders

ë The development of quality service

ë The building of self-reliance and participation

in health care in individuals

ë The building of immunity against mental

disorders in individuals

ë Education of the public on methods of

safe-guarding personal, family and

ë Community mental health.

8. The Bureaucratic Reforms and

Disaster Mental Health Period (2002-2006).

Although the political reforms and trends had been

launched under the 1997 Constitution, the bureaucratic

reform programme itself, as never before seen in the

nationûs history, really started at the end of 2001 to the

year 2002. The universal coverage or 30 - Baht health

care scheme was implemented. New Ministries emerged

and the Ministry of Public Health was reformed.

The main goal of the health reform is to produce


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universal public well - being, sound physical and mental

health and quality of life for the Thai people. The Ninth


(2002-2006) focused on people as a centre for

development. In accordance with the national plan, MoPH

started the çHealthy Thailandé Policy. This policy

focused on 12 health indicators of which two indicators

related to mental health i.e. decrease suicidal rate and

increase the average I.Q of Thai children.

The bureaucratic reform programme which aimed

to change the structure and mechanism of mental health

operations was tested when the tsunami struck

the southern part of Thailand. The Mental Health

Operations Center (MOC) was immediately established

at the Department of Mental Health to supervise and

cooperate with other concerned organisations at the

provincial, ministerial, and national levels. The rapid and

effective response of the Thai MoPH has been noted in

the MMWR weekly report by the CDC of the US

Department of Health and Human Service.4 Later on,

WHO SEARO recognised Thailand as having ça good

practiceé to deal with acute mental health effects in

tsunami survivors.

9. The Sufficiency Economy and Gross

National Happiness Period (2007 - Present)

Since September 2006, the interim government has

decided to adapt the çSufficiency Economyé approach

to economic policy to ensure stability and public

happiness. Moreover, the government will not only

focus on gross domestic product (GDP) but also on

gross national happiness (GNH). This leads the Tenth


(2007-2011) to focus on happiness of the Thai people.5

The çSufficiency Economyé is his Majesty King

Bhumibholûs philosophy with three basic principles

intertwined: moderation, reasonable, and caution or

risk management.6

A recent national survey by the Assumption

University Poll founded that Thai people who lived their

life with the sufficiency economy approach were three

times happier than those who did not. The Department

of Mental Health is now joined with the National

Council for Economic and Social Development to

develop the national indicators for the happiness and

well being of Thai people.

ConclusionPsychiatry in Thailand has undergone continuous

improvements so far beyond anyoneûs dreams of 1889,

nearly 120 years ago, particularly in more recent years.

However, due to a shortage of psychiatrists and other

mental health workers, there are some problems to be

solved. Efforts have been made to seek support and

cooperation from other agencies and to encourage

responsibility for mental health care among the general

public. With the many strategic plans that have been

implemented, we hope and expect a brighter future for

Thai psychiatry within the next decade.

References1. Udomratn P. Psychiatry in Thailand. In : Chiu E,

Chiu H, Kua EH, Yu X, eds. Textbook in Psychiatry

for Asia. Beijing : Peking University Medical Press,

2006:234-9.

2. Udomratn P. Mental health and psychiatry in

Thailand. International Psychiatry 2007; 4:11-4.



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3. Siriwanarangsan P, ed. Mental Health in Thailand

2000 - 2001. Bangkok:ETO Press; 2001.

4. CDC. Rapid health response, assessment, and

surveillance after a tsunami-Thailand, 2004 - 2005,

MMWR 2005; 54:61-4.

5. Udomratn P. Happiness, mental health, life and

sufficiency economy. J Psychiatr Assoc Thailand

2006; 51:292-7.

6. Tantivejkul S. Good mental health through the

sufficiency economy approach. J Psychiatr Assoc

Thailand 2006; 51:282-8.

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